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lStah of mi nv,onmenly l on.Agr ncy f <br /> P O No. 050-IXl39(Eepaes R,30-991P See Instructions Olt batt( age 6. Department of Toxic Substances Cor <br /> PLb,.P or typo. Fares designed for use on time f I2-prkf)i-rypewribc �- Sacmanmia,California <br /> UNIFORM HAZARDOUS T. Generatoes US EPA ID No. Monlfed Ddcuesent No. 2. Page 1 Information in the shaded areas <br /> j'. is not required by Federal law. <br /> WASTE MANIFEST CAL 0 0 0 1 1 1 0 1 5 / d �� 1 of 1 n <br /> 3, Generaft/s Nome and Mailing Address Manifest Dacumee Runt <br /> _ rV "� <br /> P.S. RENTALS _-- L - <br /> $ 2801 E. CHARTER WAY, STOCKTON, CA 95205 Generator"ID <br /> h A. Generate:s Phone ( 9) 948-9241 <br /> ,efN 5. Transporter 1 Company Name 6. US EPA ID Number Transporter'.ID <br /> sn <br /> m ransportar's Phone <br /> 8 - <br /> m ' 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporte"ID <br /> -o F. Transporter',Phone <br /> V 9. Designated Facility Nome and Sift Address 10. US EPA ID Number G. Stgte�oci' <br /> N <br /> V—iZ D/-K ENVIRONMYrAL L <br /> � -Iad 3650 EAST 26TIT STR FT, LOS ANGELES, CA 90023 H. Facility's Phone <br /> �O 11. US DOT Description rndudin Proper Shipping Name,Hazard Class,and ID Number 12. Containers 13. Total Id. Uru <br /> C:) <br /> V ( g p pp� 8 ) No. Tye Quantity Wt/Vol I. Waste Number <br /> 00 <br /> G)F NO`T—RCRA HAZARDOUS WASTE SOLID State <br /> 3 G (OIL, ABSORBENT) NAERG96#171 T 0 EPA/ahe, NP/h <br /> E Sate �V -- <br /> e b M NPS BEE D \F\ED <br /> SPA/O her <br /> v A {f� <br /> m R a. FOR aF.�VC�I MENRp�FPC\U\H Ff �iCC� `R`,� .EPA/Other <br /> OR \�� ^-?Eli• <br /> LIJ f R is state <br /> d CPI�M\RSj` RECEIVENgER SCFSOE'J EPA/aha, <br /> ru €R R E <br /> - '' K. Handling Cade,for Wastes Listed Above <br /> a MAI <br /> b. <br /> LIUd <br /> J j,• <br /> Z 15. Special Handling Instructions and Additional Information <br /> ° s/og i�v l9 <br /> a HANDLERS BE 40 HOUR OSHA/SARA TRAINED N 53 I`�� <br /> Z <br /> W AND USE NIOSH APPROVED PPE; ,7//%) <br /> € EMERGENCY CONTACT: 916 371-5747 <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurotely described above by propership ing nameandaresdisa ified,packed, <br /> Umarked,and labeled,and are in all resp«h in proper condition for transport by highway according to applicable inftrnational and nation7government regulations. <br /> J If I am is large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be ecanomicollyy <br /> S practicable and that I have selected the prodicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human Keith <br /> and the environment;OR,if I am a small quantity generator,I have made a good Faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> 0 <br /> �. Printed/Typed Name Signature Month Day Year <br /> m T 17. Tranev orftr 1 Acknowl em •/ <br /> w l Printed/Typed Name • s Signature 1 Mont^h'7 Dap, Ye r <br /> LL y18. Transporter 2 Acknow sci meent of Recei t of Materials <br /> O R <br /> T Printed/Typed Name Signature Month Day Year <br /> w E <br /> R <br /> j Lia 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> L <br /> 1 I 2CV72htiliaOwn.,or Opermesn,CertiB< 'on-.1y.c.iol of hazardous materials bythis O.ifiet exEa t as rmMd'n I 19. <br /> T 1 P oradPllj Name tgnaNr <br /> Y cf <br /> V DO NOT W BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO ENER OR WITHIN 30 DAYS. <br /> 22A(4/97) (Generators who submit hazer este for transport out-of-slate, <br /> DTSC 80 <br /> EPA 87022A produce completed copy of this copy and send to DTSC within 30 days.) <br /> �t <br />